Officials at the CDC have determined that there is a multistate E. coli outbreak, including in New Jersey, where the state Department of Health has been working with the CDC and FDA on an investigation into of E. coli cases in four counties.

According to a news release on the CDC website, CDC, several states, U.S. Food and Drug Administration, and U.S. Department of Agriculture’s Food Safety and Inspection Service are investigating a multistate outbreak of Shiga toxin-producing E. coli O157:H7 infections. This investigation includes E. coli O157:H7 infections recently reported by the New Jersey Department of Health.

As of April 9, 17 people infected with the outbreak strain of E. coli O157:H7 have been reported from seven states, including New Jersey, Pennsylvania, Connecticut, Ohio, Missouri, Washington and Idaho.

Last week, the NJDOH said that it was investigating E. coli cases in Somerset, Hunterdon, Middlesex and Warren counties, according to department spokeswoman Donna Leusner.

The case breakdown is four in Hunterdon, one in Warren, one Middlesex and two in Somerset.

"Eight people have been hospitalized and five of those individuals have been discharged," Leusner said.

People infected with the outbreak strain of E. coli O157:H7, by state of residence, as of April 9, 2018 (n=17)(Photo: ~Courtesy of CDC)

The investigation is still ongoing and a specific food item, grocery store, or restaurant chain has not been identified as the source of infections. CDC is not recommending that consumers avoid any particular food at this time. Restaurants and retailers are not advised to avoid serving or selling any particular food.

If a source is identified, officials said they would update that advice accordingly.

Public health investigators are using the PulseNet system to identify illnesses that may be part of this outbreak. PulseNet is the national subtyping network of public health and food regulatory agency laboratories coordinated by CDC. DNA fingerprinting is performed on E. coli bacteria isolated from ill people using techniques called pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS). CDC PulseNet manages a national database of these DNA fingerprints to identify possible outbreaks. WGS gives a more detailed DNA fingerprint than PFGE.

Illnesses reported by investigators in New Jersey also included ill people who had a diagnostic test showing they were infected with E. coli bacteria. Laboratory testing is ongoing to link their illnesses to the outbreak using DNA fingerprinting. Some people may not be included in CDC’s case count because no bacterial isolates are available for the DNA fingerprinting needed to link them to the outbreak.

According to the CDC, illnesses started on dates ranging from March 22 to March 31. Ill people range in age from 12 to 84 years, with a median age of 41. Among ill people, 65 percent are female. Six ill people have been hospitalized, including one person who developed hemolytic uremic syndrome, a type of kidney failure.

No deaths have been reported.

People infected with the outbreak strains of E. coli O157:H7, by date of illness onset*(Photo: ~Courtesy of CDC)

The source of this outbreak has not yet been identified, said officials at the New Department of Health, and local public health officials are interviewing ill people to determine what they ate and other exposures in the week before their illness started.

CDC will provide more information as it becomes available, and the investigation is still ongoing.

While those who are infected with E. Coli usually get better by themselves within about five to seven days, some illnesses can be serious or even life-threatening. People are encouraged to contact their health care provider if they have diarrhea that lasts for more than three days or is accompanied by high fever, blood in the stool, or so much vomiting that they cannot keep liquids down and they pass very little urine.

In addition, about 5 to 10 percent of people who are diagnosed with Shiga toxin-producing E. coli infection develop a potentially life-threatening complication known as hemolytic uremic syndrome (HUS). HUS develops about seven days after symptoms first appear, when diarrhea is improving. Clues that someone is developing HUS include decreased frequency of urination, feeling very tired, and losing pink color in cheeks and inside the lower eyelids. Any who develop these symptoms should seek out medical care.

It can be very difficult to determine where someone got sick, officials at the New Jersey Department of Health said. Individuals could have eaten a number of meals in a number of places before becoming ill. They could have eaten at several restaurants, at home or eaten food purchased at a supermarket.

According to officials, sometimes the food source associated with illness is never determined. That is the reason why public health officials conduct many interviews with sick individuals to get food history data and work with food safety officials to investigate food sources.